Healthcare Provider Details

I. General information

NPI: 1972528941
Provider Name (Legal Business Name): HUBERT KIM CHANG DC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 09/04/2022
Certification Date: 09/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6301 BEACH BLVD STE 109
BUENA PARK CA
90621-4030
US

IV. Provider business mailing address

16377 LAS CUMBRES DR
WHITTIER CA
90603-1139
US

V. Phone/Fax

Practice location:
  • Phone: 714-675-4817
  • Fax:
Mailing address:
  • Phone: 714-675-4817
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NS0005X
TaxonomySports Physician Chiropractor
License NumberDC25672
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: